Scandal of doctors paid more to do less

Senior hospital doctors have received pay rises of up to 28 per cent following
the introduction of a “nonsensical” contract that allows them to refuse to
work in the evenings and at weekends, a report warns.

Taxpayers are now faced with an annual bill of almost £6 billion for the most qualified doctors, who are typically receiving six-figure salaries, despite growing concerns over the quality of care being offered at many hospitals outside of normal hoursPhoto: ALAMY

An investigation by the public accounts committee concludes that the productivity of consultants “continued to decline” over the past decade as new terms and conditions for those working for the NHS were introduced.

The inquiry found that 60 per cent of consultants were qualifying for special bonuses that are supposed to be restricted to those doctors demonstrating exceptional performance.

Taxpayers are now faced with an annual bill of almost £6 billion for the most qualified doctors, who are typically receiving six-figure salaries, despite growing concerns over the quality of care being offered at many hospitals outside of normal hours.

A report last year found that patients admitted to hospital at the weekend were 40 per cent more likely to die than those treated during the week.

Some NHS trusts are having to make additional payments of up to £200 an hour to doctors who agree to work at weekends. In the report, the committee of MPs concludes that the hospital consultants’ contract offers “poor value for money”.

Health ministers today said the deal offered to consultants by the last government had been “absurdly naive” and needed to be renegotiated.

Many of the problems uncovered by the MPs mirror those identified in an analysis of the GP contract, which also offered generous pay rises while scaling back out-of-hours care.

Tonight, Margaret Hodge, the chairman of the PAC, said: “A new contract which increased consultants’ pay by between 24 per cent and 28 per cent failed to halt a continuing decline in productivity. Many of the improvements envisaged by the Department [of Health] were achieved but that’s because its objectives were absurdly unambitious. The contract allows consultants to refuse to work during evenings and weekends. As a result, hospitals struggle to provide the appropriate level of consultant-led care for patients. Some trusts even pay up to £200 an hour for additional work which is done at weekends.”

The report also highlights the failure of the NHS to link doctors’ pay to performance.

It criticises the release of tables that are supposed to allow patients to compare surgeons and identify whom they wish to treat them. Although a “good idea in principle”, the MPs say that the figures being published “remain poor and are not transparent”.

Clinical Excellence Awards, costing £500 million a year and intended to reward performance that is over and above that which is normally expected, are also singled out for criticism, as they have actually been paid to about 60 per cent of consultants.

“This nonsense highlights how badly consultants’ performance is being managed,” Mrs Hodge said. “A proper culture of performance management for consultants and other NHS staff must be implemented if we are to avoid incidents of poor performance.”

The committee said improved monitoring was “essential” to avoid another care scandal after hundreds of suspicious deaths at Stafford Hospital. It recommends that a new contract be introduced that demands seven-day working and caps payments for additional hours. A more sophisticated system that offers doctors higher pay to work in certain areas and specialities suffering from shortages should also be considered.

Tonight, Dr Dan Poulter, a doctor and health minister, said that reform of the contract was necessary. “This is yet another example of the Labour government being absurdly naive when negotiating contracts with the medical profession,” he said. “Medical contracts need to reward doctors fairly … but must also provide a service which benefits patients, and change in this area is long overdue. That’s why we have begun discussions on making changes to the consultant contract and clinical excellence awards.”

The British Medical Association (BMA), which represents doctors, accused the committee of using “barbed rhetoric” and said the criticism of performance awards was unfair. Dr Paul Flynn, the chairman of the BMA’s consultants committee, said: “The public accounts committee report tries to use productivity statistics as a justification to attack the terms and conditions of hard-working doctors.

“But these statistics take little account of the quality of patient care or of changing working patterns elsewhere in the hospital … the perversity of using these statistics to measure the value of consultants is that we are judged to be less productive if we spend more time with our patients.”

He said that the BMA was in exploratory talks with NHS employers about many of the issues discussed in the report, but added: “The barbed rhetoric from the public accounts committee describing the system for awarding excellence as 'nonsense’ is particularly unhelpful at a time when we are trying to come up with some broad principles for potential negotiations.”

Consultants account for 4 per cent of NHS staff but their pay amounts to 13 per cent of all NHS employment costs. The 40,000 consultants working in the health service were paid £5.6 billion in 2011-12 — an average of £140,000 each — according to the committee’s report.

Mr Hunt and Sir David Nicholson, the outgoing head of the NHS, will today appear before MPs and are expected to be questioned over plans for improving the standard of care in hospitals.